The lengthening over nail (LON) technique is a combined lengthening method that integrates the advantages of both external and internal fixation. In this review, the indications, contraindications, surgical technical details, postoperative follow- up protocols, and possible complications of the LON technique in femoral and tibial lengthening surgeries are discussed. The method is preferred in both congenital and acquired limb length discrepancies, as it allows simultaneous correction of deformities and shortens the duration of external fixator use. Proper preoperative planning, deformity analysis, and accurate implant selection are critical for achieving successful outcomes. In surgical practice, preventing technical errors during the positioning of the external fixator and intramedullary (IM) nail is essential for smooth distraction. In the postoperative period, a rehabilitation program, meticulous pin site care, and regular radiological follow-up can reduce the risk of complications. The most common complications include mechanical jamming, pin tract infection, premature consolidation, joint contractures, and implant failure. Compared with using only an external fixator or only an internal lengthening method, the LON technique significantly shortens external fixator time, is more cost-effective, and eliminates the lengthening limitations observed in internal methods, thereby offering high patient comfort and functional preservation. However, the risk of deep infection due to the presence of the IM nail should be considered, and patients should be informed.